
  <div class="x_panel">
    <div class="x_content row">
      <div class=" col-md-6 col-sm-12 col-xs-12">
        <form class="form-horizontal form-label-left" action="{$actionUrl}" method="post">
          <div class="form-group">

            <label class="control-label col-md-4 col-sm-4 col-xs-12">充值卡：</label>
            <div class="checkbox col-md-8 col-sm-8 col-xs-12">
              <select class="form-control" name="form[play_id]">
                <option value="0">请选择</option>
                {foreach $play AS $key => $value}
                <option value="{$value.play_id}">{$value.play_name}</option>
                {/foreach}
              </select>
            </div>


              <label class="control-label col-md-4 col-sm-4 col-xs-12">备注：</label>
              <div class="checkbox col-md-8 col-sm-8 col-xs-12">
                  <input class="form-control col-md-3 col-xs-12" required="required" type="text" name="form[remark]" value="">
              </div>


          </div>


          <div class="col-md-3 col-sm-12 col-xs-12 col-md-offset-4 col-sm-offset-4">
            <input name="user_id" type="hidden" value="{$user.user_id}">
            <button class="btn btn-success" type="submit">充值</button>
          </div>
        </form>
      </div>
    </div>
  </div>
